Poll Probes Health Reform Doctors Are Open To Reform, Poll Finds

American doctors will accept outside control over the way they practice medicine, a new poll shows, but are deeply concerned about health care reform measures prescribed by the Clinton administration.

Physicians say their incomes will fall, their freedom will suffer and the health of Americans will worsen if Congress adopts the "managed competition" approach touted by the White House, the survey says.

"The health delivery system will have the efficiency of the Postal Service and the compassion of the Internal Revenue Service," one Illinois doctor jokingly told pollsters for the Times Mirror Center for The People & The Press.

Yet nearly 6 of every 10 doctors responded favorably to the plan, especially when contrasted with the Canadian-style `single-payer' system, which they view as even more burdensome.

Fully three-quarters of the 501 physicians polled have a "positive disposition" toward either method for overhauling the nation's oft-criticized health care system.

"There's a gun against their head and they know it," said Bill McInturff, of Public Opinion Strategies.

Each interest in the array of health care providers is now seeking to influence a looming national debate over reform.

The Times Mirror survey found physicians willing to make some concessions but sometimes at odds with the very patients they serve.

Sixty-nine percent of the public react to rising costs with urgency; only 50 percent of physicians feel that way.

Doctors are more willing to subject their patients to longer waits for non-emergency visits. Physicians also see less need for use of the latest medical technology.

Doctors are most concerned with bureaucracy, paperwork and the threat of malpractice suits. Insurance companies and government programs such as Medicare are frequent targets.

"They question our clinical judgment, they infringe on our time with unnecessary questions, they must add significantly to the overall costs of medical care," complained a Maryland internist.

"Today's medicine is really run by the law schools," the chief of medicine at one Washington teaching hospital told pollsters, "because the insurance companies are run by lawyers."

Doctors and patients agree on one point: Health care reform should preserve a person's right to chose a physician. Both put the highest priority on guaranteeing health care for the nation's 35 million uninsured.

Doctors also emphasize the need for preventative medicine.

Telephone interviews were conducted with 501 doctors March 15-26. The interviews including 93 people in such leadership slots as medical school deans, hospital chiefs of staff and association presidents. The poll's margin of error is plus or minus 5 percent.

Pollsters also contacted 1,011 adults on April 1-4. The margin of error on those responses is plus or minus 3 percent. Times Mirror owns The Morning Call.

A majority of the public (55 percent) want the nation's health care system completely rebuilt. Nevertheless the public is unwilling, as the pollsters put it, "to pay the price of its rhetoric by accepting reduced services."

People are most worried about the rising cost of medical bills and insurance coverage, citing most often the fiscal damage posed by long-term nursing home care or a major illness. Others fear losing coverage at work.

Doctors are willing to accept a less radical overhaul. But they express little confidence in politicians to do the job.

Just one in four doctors think that Hillary Rodham Clinton's planners will make wise recommendations next month on reform, compared to 55 percent of the public. Eight in 10 doctors lack confidence in Congress to finish the job.

A majority support the Canadian system, which is similar to national health insurance. It allows people to chose doctors and it guarantees that all doctors get paid.

Slightly more of those queried prefer managed competition as less-restrictive. However, rural doctors said it would fail in areas where there are too few people to support several providers.

Solo practitioners, who are paid directly by patients and not hospitals or health maintenance organizations (HMO), rejected both plans.

Pollsters cautioned against reading too much into doctors' support for the idea of "managed competition," a model that attempts to hold down costs by creating regional cooperatives for purchasing care.

Few members of the public -- indeed, a large number of doctors -- lack precise information about the reform proposals that are driving cocktail conversation across official Washington.

Pollsters had to provide details of managed competition to six in 10 doctors being interviewed. Surveys show wild fluctuations in results if questions are posed slightly differently.

What the numbers do reflect, pollsters and analysts say, is the medical profession's willingness to play along -- at least for now.

"The industry is not obstructionist, not pro-gridlock," said Michael Bromberg, of the Federation of American Health Systems, a group that represents for-profit hospitals. "The politicians underestimate the profession's willingness to cooperate."